JONATHAN WADE KOLLER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049139232

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

WADE

Last Name

KOLLER

Business Name

JONATHAN WADE KOLLER

Original Issue Date

11/15/2001

Effective Date

11/15/2001

Expiration Date

03/31/2003

City

DE KALB

State

Zip

60115

County

DEKALB

Ever Disciplined

LastModifiedDate

10/20/2005